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To the Editor:
COVID-19 (Coronavirus Disease-2019), caused by the coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome- Coronavirus-2), is an emerging infectious disease, recently declared pandemic by World Health Organization (WHO). On May 29, 2020, there were more than 5,900,000 confirmed cases and more than 360,000 death from COVID-19 worldwide. Data about this infection in patients with diabetes are limited at present.1 Recent papers on COVID-19 and diabetes are mainly focused on clinical management of patients,2 but they do not seem to consider the high-risk category of healthcare workers suffering from diabetes. Several studies evidenced that diabetes is notably prevalent among health care workers (HCWs), probably due to unhealthily lifestyles, obesity, and physical inactivity.3 They have also an increased risk of contracting COVID-19 due to their close contact with patients affected by SARS-CoV-2.4,5
In this outbreak, HCWs are experiencing high psychosocial strain and workload that could increase the risk of infection, particularly in the most susceptible workers, such as subjects with diabetes. There is no evidence whether HCWs with diabetes should be fully excluded from their activity in hospital in this period, although it is reasonable that they should not work in units where COVID-19 patients are directly assisted. These precautions should be taken especially for those workers with coexisting hypertension, cardiovascular disease, kidney disease, and other comorbidities, since they are likely to have further increase in the severity of disease.
It may be useful to provide general suggestions to HCWs affected by diabetes. Firstly, a good glycemic control should be particularly maintained in this period, so reducing the risk of infection and potential bacterial superinfections, which often make pandemics like COVID-19 especially deadly.
Attention to nutrition and adequate protein intake is important. Healthy balanced diet with good amount of proteins, fiber, and limitation of saturated fats is important to maintain a good glycemic control. Fatty and fried foods also make it hard to control blood glucose levels. HCWs with diabetes should minimize intake of alcohol and junk food. In this period, some hospital are closing internal cafeterias or they are limiting the access to staff break areas, so a vending machine is often the only option for a quick snack. Before work, HCWs with diabetes should consume a meal in which complex carbohydrates (such as bread, rice and cereals) are present, including foods containing whole grains. They help to maintain a good level of glucose in the blood, thus avoiding the risk of hypoglycemia during the shift. Instead, foods rich in simple sugars such as candies, sweet drinks, and chocolate could be useful in case of hypoglycemia, since they cause a rapid increase in glycemic levels.
Physical activity is important and should be continued, since it seems to improve immunity.6 Home based exercise like cycling, treadmill, stationary jogging could be beneficial. HCWs are normally inclined to do less physical activity,4 and this condition could be worsened by the COVID-19 outbreak that confined HCWs to small physical areas.
Since night-shift work is associated with poorer glycemic control in patients with diabetes, working schedule should be reconsidered.7 Longer duty hours should be limited, since they appeared to be a risk factor for COVID-19.8 Furthermore, any clinician or care professional working within 2 m of a confirmed or suspected COVID-19 patient should wear an apron, gloves, a surgical mask, and eye protection. No doubt, they can be so uncomfortable and warm that wearing them for prolonged duration may result in dehydration. The prolonged use of personal protective equipment limits to eat snacks during your shift to keep blood glucose levels from dropping quickly. For these reasons, shortened shifts for HCWs with diabetes should be considered and, similarly, the amount of overtime should be eliminated or significantly reduced.
Isolation from their relatives and friends could lead to harmful coping strategies like smoking, vaping, and drugs. For this reason, psychological support should be guaranteed to HCWs, especially to subjects affected by chronic diseases, such as diabetes.9
In conclusion, we invite general practitioners, clinicians, and experts of diabetes and its complications to have greater attention towards diabetic patients at risk for their working activity, including towards diabetic workers in non-health settings.10 A close collaboration between the occupational physician and the diabetologist is desirable on this issue.
1. Ma RCW, Holt RIG. COVID-19 and diabetes. Diabet Med
2. Poulsen K, Cleal B, Clausen T, Andersen LL. Work, diabetes and obesity: a seven year follow-up study among Danish health care workers. PLoS One
3. Cena H, Chieppa M. Coronavirus disease (COVID-19 - SARS-CoV-2) and nutrition, is the Italian infection suggesting a connection? Front Immunol
4. Belingheri M, Paladino ME, Riva MA. Beyond the assistance: additional exposure situations to COVID-19 for healthcare workers. J Hosp Infect
5. Belingheri M, Paladino ME, Riva MA. Risk exposure to COVID-19 in pregnant healthcare workers. J Occup Environ Med
6. Jiménez-Pavón D, Carbonell-Baeza A, Lavie CJ. Physical exercise as therapy to fight against the mental and physical consequences of COVID-19 quarantine: special focus in older people. Prog Cardiovasc Dis
7. Manodpitipong A, Saetung S, Nimitphong H, et al. Night-shift work is associated with poorer glycaemic control in patients with type 2 diabetes. J Sleep Res
8. Belingheri M, Paladino ME, Riva MA. Working schedule, sleep quality and susceptibility to COVID-19 in healthcare workers. Clin Infect Dis
9. Greenberg N, Docherty M, Gnanapragasam S, Wessely S. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ
10. Belingheri M, Paladino ME, Riva MA. COVID-19: health prevention and control in non-healthcare settings. Occup Med (Lond)